Financial Aid
Office
2019-2020 Dependency Override Request Form
The Department of Education determines a student’s status as dependent or independent by the answers the
students provides on the Free Application for Federal Student Aid (FAFSA). To be considered independent of
your parents for financial aid purposes, you must prove that one of the following is true:
Be born before January 01, 1996; or
Be a graduate or professional student; or
Be married on the day you apply for financial aid (being separated still counts as being married); or
You have children who receive more than half of their support from you; or
You have dependents other than children who live with you and receive more than half of their support
from you; or
You are an orphan (both parents are deceased); or
You were a ward of the court until age 18 or were a foster child after the age of 13; or
You were/are in legal guardianship; or
You were /are an emancipated minor; or
You are an accompanied youth who was homeless or at risk of homelessness on or after July 1, 2018; or
You are serving a
ctive duty in the U.S. Armed Forces (other than training) or a U.S. Armed Forces
veteran; or
You have special and unusual extenuating circumstances that can be DOCUMENTED for your financial aid
administrators, who may then request a “dependency override” on the FAFSA appli
cation.
(NOTE: Exceptions are granted very rarely and only in extreme cases.)
If NONE of the above criteria apply to you, you are a DEPENDENT student.
IMPORTANT:
Many students feel that they should be able to declare INDEPENDENT status because they live on their own, file
their own taxes, or receive no support from their parents, but those reasons will not constitute as extenuating
circumstances to merit a dependency override. Unfortunately, the Department of Education is extremely strict
with regard to determining dependency status.
DIRECTIONS:
After reading the information above carefully, if you feel you can substantiate an
extenuating circumstance, then complete this form and the Third Party Verification Form and submit it to
THE FINANCIAL AID COMMITTEE DECISION IS CONSIDERED FINAL AND CANNOT BE APPEALED
Rev. 3/15/2019
the F
inancial Aid Office (FAO). Your request will be reviewed by the FAO. Committee.
(Dependency Override Form - Please answer ALL of the following questions:)
Biological MOTHER
Deceased : Yes ( ) No ( ) Don’t Know ( ) FATHER Deceased : Yes ( ) No ( ) Don’t Know ( )
Parents
Name: _____________________________________ _______________________________________
Address: _____________________________________ _______________________________________
_____________________________________ _______________________________________
Phone #: _________________________________ ___________________________________
1.
When was the last time you lived with your Mother? ______________ With your Father?_____________
Month / Year Month / Year
2
. When was the last time you had contact with your Mother? __________ With your Father?___________
Month / Year Month / Year
3
. When did your Mother last provide support? ______________________ Your Father?_______________
Month / Year Month / Year
4.
What are your present living arrangements (Who do you live with? How much do you pay each month for
Rent? When did this arrangement begin?)
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
5. How do you support yourself and meet your current living expenses?
_____________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
6. Why are your parents no longer able to support you? Explain in detail the circumstances involving your
parents inability or unwillingness to support you. Attach a separate sheet of paper if necessary to provide
additional information that you feel supports your request to be considered as an independent student.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
FOR OFFICE USE ONLY: Using Professional Judgment, this Student is:
Independent______ Dependent _______
STUDENT:
Last Name:___________________________ First Name:_______________________ Contact Phone# : _____________________
Student ID#: ______________________ SSN (Last 4-digits): ____________
Date of Birth: _______/______/_________
Address: _______________________________________________________________________________________________________________
Street City State Zipcode
I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AND I UNDERSTAND THAT IT MAY BE
USED TO OVERRIDE FEDERAL REGULATIONS REGARDING MY DEPENDENCY STATUS. IF I PURPOSELY GIVE
FALSE OR MISLEADING INFORMATION ON THIS FORM, I MAY BE FINED $10,000, SENT TO PRISON, OR BOTH.
_____________________
_________________________ ____________________
Student Signature
Date
Comments:_____________________________________________________________________________
_____________________________________________________________________________________
Rev. 3/15/2019
Financial Aid and
Scholarship Office
Third Party Verification
To The Student: PLEASE GIVE THIS FORM TO THE THIRD PARTY PROFESSIONAL SUCH AS COUNSELORS,TEACHERS,
CLERGY, COMMUNITY GROUPS, GOVERNMENT AGENCIES, MEDICAL PERSONNEL, COURTS, OR POLICE OFFICER/
ADMINISTRATORS WHO HAVE KNOWLEDGE OF THE UNUSUAL CIRCUMSTANCES OF YOUR SITUATION. HAVE THE THIRD
PARTY REPRESENTIVE COMPLETE THE WRITTEN VERIFICATION FORM WITH AN OFFICIAL LETTERHEAD OR SUBMIT AN
OFFICIAL BUSINESS CARD ALONG WITH THIS FORM.
STUDENT NAME:__________________________________STUDENT ID#:_____________________Date of Birth:________________
Please describe the above named student’s home situation with his/her parents in enough detail so then the
financial aid office may determine if there is an adverse home situation. (attach additional sheet if
necessary and be sure to sign statement and attachments)
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_____________________________
I Certify that the above statement is true and correct to the best of my knowledge. I
understand that I may be contacted by a financial aid administrator for verification of
information.
_____________________________________________________
Third Party Signature
__________________________
Date
____________________________________________________ ___________________________
Third Party Name Printed Contact Telephone Number
___________________________________________________ ______________________________________________________
Address City State Zip Code
__________________________________________________________ ____________________________
Relationship to Student Length of time Known Student
Rev. 3/15/2019